A CASE OF TRANSOMENTAL HERNIA SUFFERED FROM RECURRENT ILEUS FOR SEVERAL YEARS

Abstract

Transomental hernia is rare, but known to be difficult to diagnose preoperatively. We report a rare case of transomental hernia, which suffered from recurrent ileus for several years. An 86-year-old woman had noticed an abdominal tumor several years before, and had suffered recurrent ileus conditions. This time, the woman was admitted for abdominal pain and vomiting, and a fist-sized tumor was palpated in the lower abdomen. An abdominal CT revealed a dilatation of the jejunum, but could not detect the pathogenesis. Under a diagnosis of ileus, we conducted conservative long tube therapy but to no effect, so Surgery was undertaken 7 days after admission. Laparotomy disclosed that about 30 cm of the jejunum was incarcerated through a defect of the greater omentum 3 cm in diameter. It seemed that this incarcerated intestine was the preoperative abdominal tumor itself. The defect of the greater omentum was opened, and the incarcerated jejunum was reverted. The impacted intestine was not necrotic, so it was not resected. The postoperative course was uneventful, and the preoperative abdominal tumor disappeared. The possibility of a transomental hernia should be kept in mind when treating ileus patients with surgery, because it often progresses to fatal necrosis of the intestine.